Putting Fences Around Medical Marijuana Use
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Putting Fences Around Medical Marijuana Use
Posted by CN Staff on January 31, 2010 at 06:13:02 PT
By Kelly Brewington and Meredith Cohn
Source: Baltimore Sun
Baltimore, M.D. -- Even as a proposal to legalize medical marijuana emerges in Maryland, a backlash over the burgeoning industry has developed in other states - and is likely to influence legislation here.Last week, the Los Angeles City Council tried to rein in the growth of marijuana dispensaries, limiting the number to 70 and imposing tight restrictions on where and how they can operate. And in Colorado, towns are trying to shutter some of the hundreds of dispensaries that have popped up.
But supporters of the Maryland proposal say they have learned from problems in states that approved use of the drug without uniform regulations on the dispensaries providing it. The result, they say: Maryland's measure could be among the most stringent in the nation."I looked at a compendium of legislation from all the other states and I knew from being in California that we absolutely didn't want to do that," said Del. Dan Morhaim, a Baltimore County Democrat and a physician who plans to sponsor a bill that would make Maryland the 15th state to allow the medical use of marijuana. "From the physician-patient point of view, I wanted a bill that I would be supportive of as a doctor."Advocates and some medical experts say a growing body of research shows the drug can be an effective tool to help patients struggling with some diseases. The Maryland proposal would allow marijuana to be given to patients with a "debilitating medical condition," such as seizures, severe chronic pain or severe nausea as a result of cancer treatment.But not all physicians agree it's a good idea.Dr. Kevin Cullen, an oncologist and director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center, isn't sure the state needs a new law. He said he'd probably never recommend medical marijuana to cancer patients because other drugs are more effective."It's important that the lawmakers speak to the medical community directly and assess the need for this," he said. "It may be that they're having a 'me, too' reaction to other states. I have no idea who the lobby may be for this."Unlike laws in some other states, the proposal Morhaim discussed last week would license growers and dispensaries, would allow doctors to recommend marijuana only to patients with whom they have a long-standing relationship and would control who could provide the drug to homebound patients. People would not be able to grow their own marijuana and would be limited in the amount they could buy each month as well as the ailments they could use it for.(Sen. David Brinkley, a Republican from Frederick, is the measure's sponsor in the Senate.)Morhaim, a longtime medical-marijuana supporter, said this legislative session is the right time to pursue the change.Last fall, the American Medical Association urged the federal government to downgrade its classification of marijuana from a dangerous drug with no medical use, clearing the way for more clinical research of the drug and development of cannabis-based medicines.At the same time, access to medical marijuana has been growing nationwide since the Obama administration loosened federal enforcement of the drug last fall, saying it would not prosecute users in states with medical marijuana laws. With other states legalizing medical marijuana, Maryland had an opportunity to study their successes and missteps.In crafting the measure in the House of Delegates, Morhaim, who is originally from Los Angeles, looked at that city's experience with medical marijuana as an example of what not to do.Because California's 1996 law legalizing medical marijuana did not regulate dispensaries or set up a means for distributing the drug, localities had to come up with rules on their own. While cities such as Oakland mandated regulation of dispensaries, including restrictions on where and how they can operate, Los Angeles left the question open; storefront dispensaries with on-site doctors flourished across the city."I don't want doctors who will just write an open-ended marijuana prescription to a patient they just met," he said. "I am quite aware of the L.A. problem; it's clearly out of control."Similarly in Colorado, which has had a medical marijuana law since 2000, towns have begun trying to close dispensaries. Until last year, there were only about a dozen dispensaries statewide. Since then, hundreds have opened, serving about 40,000 patients.But the state didn't address dispensaries in the law, creating a lack of uniformity in how they operate, said Brian Vicente, co-chair of Colorado's Sensible Patient and Provider Coalition. The coalition includes medical marijuana advocacy groups, business owners, caregivers and patients who are seeking some new regulation of medical marijuana.The Colorado law said only that sick patients with a doctor's permission could possess and cultivate marijuana - or appoint a caregiver to do it for them if they were too sick or didn't have the expertise. One caregiver could handle many patients - the patients would merely have to designate the person as their caregiver. Some caregivers began opening stores, a boon to those who can't or don't want to grow their own marijuana and don't want to buy it "on the street or in an alley," he said.The Maryland proposal hopes to avoid that situation by allowing caregivers to serve only one patient, Morhaim said.Vicente said most dispensary owners are paying taxes and working to help sick people, but the coalition fears "a select handful are probably breaking some laws."In the meantime, he said, towns have reacted differently. Denver "embraced them," and has written regulations for the dispensaries. But Centennial, Colo., tried to close its dispensary and the owners sued.Maryland, he said, has an opportunity to set a statewide, even national, standard for how to deal with the medical-marijuana issue by establishing a system of uniform taxation and regulation of dispensaries - no squabbling over rules.But Vicente also warns the lawmakers not to make the rules too restrictive. The state should let patients grow marijuana, because it's cheaper than prescription medication, he said, and many patients can't afford traditional health care. Also, requiring a recommendation from a long-time doctor would be a problem for patients whose physicians fear federal prosecution or just won't write a referral.Maryland lawmakers suggest having growers be licensed by the Department of Health and Mental Hygiene and the Department of Agriculture, which would charge a licensing fee. Growers would have to submit to regular testing and monitoring."If you're going to have people use this, you have to make sure it's a safe and secure unadulterated supply. Grow-your-own approach opens the door to all kinds of misuses," Morhaim said.Meanwhile, doctors disagree over whether marijuana is even helpful for their patients, and whether they would prescribe it.Cullen, the UM cancer specialist, said marijuana is a carcinogen, and when you're treating people with cancer you don't want to expose them to more carcinogens. He also said marijuana is used as an anti-nausea medicine, but newer medicines developed in the past 10 years are better. And, finally, the active ingredient in marijuana has been made available as a pill, called Marinol, for those with chemotherapy induced nausea."It's rarely used because it doesn't work as well as newer medications," he said. "And most patients don't like the feeling they get from Marinol on top of chemotherapy."Cullen said he's "fairly agnostic" on medical marijuana for other purposes, but for cancer it's not a useful drug.Dr. Steven P. Cohen, a pain specialist and an associate professor of anesthesiology at the Johns Hopkins School of Medicine, said he would recommend marijuana to patients, but only after other therapies had failed. He'd make sure patients were responsible, compliant and informed about the risks of the drug and would agree to routine monitoring.Marijuana, and the class of marijuana-like drugs called cannabinoids, can be effective treatment for people with central nervous system pain, such as those with multiple sclerosis and stroke, said Cohen. "For these patients, it would be great; these things are notoriously hard to treat."But there's no research on the long-term effects of the drug and few can justify using it as a first-line treatment, he said."Some studies have shown efficacy in the short-term, like six weeks or two months, but what happens after a year?" he said. "Especially if you smoke, you have questions about motivation, memory problems, there may be risks for cancer, bronchitis, lung disease and emphysema."Still, because treating pain is so complicated and few drugs offer long-term relief, Cohen doesn't see a problem with adding marijuana as another tool to help patients."People die from opioids, I see it all the time," he said. "They are probably inherently more dangerous than cannabinoids and they are used all the time for chronic pain. So why wouldn't you use cannabinoids?"Source: Baltimore Sun (MD)Author: Kelly Brewington and Meredith CohnPublished: January 31, 2010Copyright: 2010 The Baltimore SunContact: letters baltsun.comWebsite: Medical Marijuana Archives 
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Comment #11 posted by The GCW on February 02, 2010 at 21:31:03 PT
Other anti-nausea medicines aren't a substitute fo
US MD: PUB LTE: Other anti-nausea medicines aren't a substitute for marijuana,0,3607233.storyThis comment is in regard to the article "Putting Fences Around Marijuana Use" (Jan. 31).As someone who is in frequent contact with people suffering from sarcomas (rare, aggressive cancers), I would like to point out that most of the quoted physicians' objections to medicinal marijuana use center on it's ingestion as a smoked product. Perhaps providers of medicinal marijuana should be required to supply edible marijuana products that do not incur these risks.In regards to pharmaceuticals designed to reduce nausea, many of those have side effects that cause patients real distress. Changing anti-nausea medications in the midst of a nausea-causing event, such as chemotherapy, is a difficult process. It puts patients, their families and caregivers into crisis mode until, by trial and error, a solution is found.Testing the efficacy of marijuana use is a quick process and if it works, it should be allowed to continue for that patient, legally. This is humane use. It isn't helpful to nitpick what it can and can't be used for at this point, whether for cancer treatment or relief of neurological symptoms, the research just isn't there. If regulated clinics are allowed to operate, statistics can be generated.CONT.Coming to MAP
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Comment #10 posted by josephlacerenza on February 01, 2010 at 05:17:33 PT
Norm Stamper got it right! These drug warriors need new tactics, or at least new material!!
Drug Warriors: Addicted to Myths
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Comment #9 posted by runruff on February 01, 2010 at 03:47:23 PT
Flat Earthers read this site!
They stole my idea to put a fence around it so the kids will not fall off.Now they want to apply my genus to their nefarious means!Suffering succotash!
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Comment #8 posted by Hope on January 31, 2010 at 21:27:35 PT
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Comment #7 posted by RevRayGreen on January 31, 2010 at 21:03:31 PT
Comment #4 posted by Hope
my all time favorite song.
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Comment #6 posted by Hope on January 31, 2010 at 20:22:03 PT
Besides being truly ignorant of how much some patients can be helped with the use of the cannabis herb, they seem to be profoundly arrogant as well. I wonder at what point self confidence morphs into arrogance?Too many doctors, I fear, are like them. Even if they're not getting grants from the federal government for something.
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Comment #5 posted by Hope on January 31, 2010 at 20:06:19 PT
Sorry bout Simon and Garfunkle
Sweet as they sing it, they can't hold a candle to a bunch of little girls, a cappella, and with very sweet joy.I had joy, too.And hope.
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Comment #4 posted by Hope on January 31, 2010 at 20:01:11 PT
fences and bridges and climbing up
They just sung my very favorite song on the Grammy's.Beautiful song. Beautiful lyrics.In my imagination, I hear it from my God. You can laugh at me and think me a bit loony... or a lot, but I have good reason to think that. On one of the saddest nights of my life, a slumber party of little girl scouts called me. First it was "Is your refrigerator running?", and lots of giggles and titters. We talked. They made me laugh. About four or five little girls, as I recall. Finally they said, "We have to do a good deed every day and the little girl talking asked if they could do a good deed for me. I said, "Like what?" They all agreed they could sing me a song. What would I like for them to sing, they wanted to know. I said, "I don't know. Whatever you want. You choose."They sang a lovely version of Bridge Over Troubled Water. The whole thing... or very nearly, surely. I was awed and amazed. Part of the very sadness of that dark night was that people I loved dearly were flying across the ocean, to be gone for a very long time, and under terrible circumstances.Some sort of true Grace made them land on me for their big prank phone call. Soooo. I'm so thankful whenever I hear it.When you're weary
Feeling small
When tears are in your eyes
I will dry them allI'm on your side
When times get rough
And friends just can't be found
Like a bridge over troubled water
I will lay me down
Like a bridge over troubled water
I will lay me downWhen you're down and out
When you're on the street
When evening falls so hard
I will comfort youI'll take your part
When darkness comes
And pain is all around
Like a bridge over troubled water
I will lay me down
Like a bridge over troubled water
I will lay me downSail on Silver Girl,
Sail on by
Your time has come to shine
All your dreams are on their waySee how they shine
If you need a friend
I'm sailing right behind
Like a bridge over troubled water
I will ease your mind
Like a bridge over troubled water
I will ease your mind
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Comment #3 posted by kaptinemo on January 31, 2010 at 18:33:10 PT:
Many thanks, Doctors Cullen and Cohen
There's an old saying that it's best to keep your mouth closed and prevent someone from thinking you're a fool than it is to open your mouth and remove all doubt that you actually are one.Someone in "Doctor" Cullen's care should immediately seek another physician, for by opening his mouth and spewing ignorance, he's proven himself a fool."Dr. Kevin Cullen, an oncologist and director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center, isn't sure the state needs a new law. He said he'd probably never recommend medical marijuana to cancer patients because other drugs are more effective."Since the 'good doctor' (spitting sound) hasn't mentioned them, I assume he's talking about artificial cannabinoids like Marinol, which is hard for a person undergoing chemo to keep down...and doesn't always work, anyway.As to "Doctor" Cohen, obviously he hasn't been keeping up with his medical journals; the Tashkin Study has been out several years now, and refutes all his concerns.When I think back on the pain and suffering I witnessed during and immediately after chemo treatments, and then have to read this kind of nonsense, I can't help but wonder if these people have any real idea of what they're doing. But I know one thing: I wouldn't let them get within ten yards of me. Their publicly displayed ignorance makes them dangerous to their patients; they're malpractice suits waiting to happen.
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Comment #2 posted by Sam Adams on January 31, 2010 at 17:48:40 PT
Pain specialist 
most pain specilists I've seen are virtual sales reps for Big Pharma. He's going to try all the drugs from the corporations that fly him out for golf weekends FIRST, then you're allowed to have the free medicine you pull out of the ground. No free buffets there! Only what the gods of nature have given us.
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Comment #1 posted by Sam Adams on January 31, 2010 at 17:46:58 PT
Dr. Dimwit
Dr. Steven P. Cohen, a pain specialist and an associate professor of anesthesiology at the Johns Hopkins School of Medicine, said he would recommend marijuana to patients, but only after other (toxic and possibly deadly) therapies had failed.More and more my feeling is that the problem is not cannabis, it's that doctors and the government have taken away our human right to take medicine. Once we lost the right to take herbal medicine it was only a matter of time before they began to force toxic drugs on the population.
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